| NPI | 1770719346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2017006060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 39972) |
| 207R00000X Internal Medicine (Licence: IA R-8689) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2022-01-26 |